A KAP model-based retrospective study on the association between fertility stress and marital adjustment in patients undergoing assisted reproductive technology

Patients undergoing assisted reproductive technology (ART) often experience considerable fertility-related stress, which may adversely affect their marital adjustment. The Knowledge-Attitude-Practice (KAP) model provides a theoretical framework for understanding patient cognition and behavior. This study aimed to investigate the relationship between fertility-related stress and marital adjustment, as well as its influencing factors. A retrospective analysis was conducted on 200 ART patients, divided into a high-stress group (n = 100) and a low-stress group (n = 100) based on the median fertility stress score. KAP model scores and marital adjustment levels were compared between groups. Pearson correlation analysis, multivariate linear regression, and subgroup analysis by educational level were employed. The high-stress group had significantly lower scores across all KAP dimensions - knowledge (68.5 ± 9.2 vs 75.3 ± 8.6), attitude (72.1 ± 10.4 vs 78.9 ± 9.1), and practice (65.7 ± 11.0 vs 71.8 ± 10.2) - as well as lower marital adjustment scores (82.3 ± 12.5 vs 91.7 ± 11.3; all P < .001). Fertility stress showed a significant inverse association with marital adjustment (r = -0.48; β=-0.37; P < .001), while higher knowledge and practice scores were independent positive predictors (both P < .01). Subgroup analysis indicated a stronger negative correlation among patients with higher education (r = -0.52 vs -0.39). These findings suggest not only statistical but also practical significance, as stress reduction and enhancement of knowledge and behavioral practice may directly contribute to better marital adaptation in clinical settings. Higher fertility-related stress is associated with poorer marital adjustment in ART patients. Marital adaptation is closely linked to KAP model components. Greater attention should be given to highly educated individuals, with targeted interventions to improve knowledge and practice capacities to alleviate stress and enhance marital adjustment.